Brain games try to tackle schizophrenia

By Hristio Boytchev, Special to The Washington Post

Posted:
02/20/2013 12:26:03 PM PST

Updated:
02/27/2013 01:51:39 PM PST

Brain games try to tackle schizophrenia By Hristio Boytchev, Special to The Washington Post Believing that brains can be trained through the use of specialized computer programs, researchers are focusing on helping people with schizophrenia, which can cause them to hear imagined voices or believe that others are controlling or plotting against them.

There are medications for the often-disabling disorder, but they have severe side effects and don't get rid of all symptoms; many people will not stick with the drugs.

A California company, Posit Science, is developing a computer game that it hopes will become the first to earn approval from the Food and Drug Administration (FDA) for treating schizophrenia.

The idea comes from Michael Merzenich, an emeritus professor of neuroscience at the University of California at San Francisco and a co-founder of Posit Science. Merzenich is something of a living legend in neuroscience, a co-inventor of cochlear implants and one of the pioneers of the theory of neuroplasticity, which asserts that the brain continues to develop throughout a lifetime.

Treating schizophrenia with brain training is based on the theory that the confusion and fear the disease creates may occur because the brain's expectations about what will happen do not match up with what actually happens. That disconnect might be traced to a problem with verbal and auditory processing of information, something that brain training targets.

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An advantage of using schizophrenia for brain-training research lies in the severity of the disease. As a result, small gains achieved via the software can be of statistical significance. The company hopes that once such gains can be shown with schizophrenia, similar training can be tested for other conditions, such as dementia and even among healthy individuals, said Henry Mahncke, chief executive of Posit Science.

"I have no doubt we will succeed, but there are a lot of variables in these experiments that can decide the outcome," Merzenich said. Clinical trials aimed at FDA approval are being conducted at a dozen sites in collaboration with the Schizophrenia Trials Network, a group of university-based researchers. The trials will involve 150 participants and finish next year.

Creating the brain-training program has not been simple. Many patients found initial versions of the game boring and stopped playing it after a couple of sessions. So Posit Science hired a game developer, who came up with a cartoonlike design, virtual characters and a mellow soundtrack. But the most important improvement in the game was giving players the chance to make virtual money.

"Schizophrenic patients often don't get to earn an income" because their social skills are limited, "so we decided to use that for motivation," Mahncke said. For achieving a particular goal — such as distinguishing between similar sounds or memorizing the location of words on the screen — players earn virtual dollars. At the end of an exercise round, when solving the repetitive tasks starts to become tedious, the amount is tripled to keep players engaged.

After players finish a session's exercises, the game lets them go to their virtual homes, where the virtual money can be used to purchase furniture and other accessories. The concept seems to work. "Most of our patients stick with the training," Merzenich said. A typical treatment consists of about five hours with the software every week for three to four months.

Sophia Vinogradov, a psychiatry professor at the University of California at San Francisco, has done research on using brain games in psychiatry. "Computer programs are especially suitable for targeting a disease like schizophrenia, because it's in the teens when most of the affected are confronted with the disease — and in that age, they are particularly receptive to the games," she said. Vinogradov has collaborated with Merzenich and Posit Science for more than a decade.

She said results of her studies show that "cognition improve[s] in schizophrenia patients. . . . Something that has not been shown with any other kind of intervention." She added that brain imaging suggests that brain-activation patterns become more efficient and normal.

"Our research is one way to show that the approach works; the FDA trials are another," she said. In one study, Vinogradov's team found improved cognition among schizophrenia patients who trained with Posit's software. A second study found improved ability to distinguish between what is real and what is not.

Murali Doraiswamy, a professor of psychiatry at Duke University Medical Center, said that while the data coming out of Posit Science are promising, other companies are making significant advances, as well.

Doraiswamy collaborates with Lumosity, an online platform for brain games. It claims to have 25 million registered users, most of whom use the games for free. (Posit Science, by contrast, develops tailored solutions for particular target groups and then sells licenses of the software.)

Lumosity wants to put its millions of players to use for science. The company may lack data about the age and mental condition of its users, but it hopes to make up for those shortcomings with sheer numbers.

Judged by their cognitive performance, most of Lumosity's users are healthy. But Lumosity co-founder Michael Scanlon estimates that about one in 10 has a medical condition. He hopes his games one day will contribute to battling dementia, a condition that some of his family members have.

Vinogradov has yet to be convinced of Lumosity's approach. "They have good ideas," she said, "but how do you do experiments without a control group?" She sees that as a manifestation of the general problem in the brain-training field — the lack of a standardized approach for how studies should be conducted.

"We are like at the beginning of vaccination research: We have yet to figure out which dosages to use, which parameters to measure," she said.